Provider Demographics
NPI:1700635927
Name:BALL, AMBER FAYE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:FAYE
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BEACON HILL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-6182
Mailing Address - Country:US
Mailing Address - Phone:606-780-0444
Mailing Address - Fax:606-784-2344
Practice Address - Street 1:333 BEACON HILL RD STE 201
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-6182
Practice Address - Country:US
Practice Address - Phone:606-780-0444
Practice Address - Fax:606-784-2344
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KYTC060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program